| Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. | |
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MedLine Citation:
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PMID: 20851923 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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RATIONALE: In the critically ill patients, lung ultrasound (LUS) is increasingly being used at the bedside for assessing alveolar-interstitial syndrome, lung consolidation, pneumonia, pneumothorax, and pleural effusion. It could be an easily repeatable noninvasive tool for assessing lung recruitment. OBJECTIVES: Our goal was to compare the pressure-volume (PV) curve method with LUS for assessing positive end-expiratory pressure (PEEP)-induced lung recruitment in patients with acute respiratory distress syndrome/acute lung injury (ARDS/ALI). METHODS: Thirty patients with ARDS and 10 patients with ALI were prospectively studied. PV curves and LUS were performed in PEEP 0 and PEEP 15 cm H₂O₂. PEEP-induced lung recruitment was measured using the PV curve method. MEASUREMENTS AND MAIN RESULTS: Four LUS entities were defined: consolidation; multiple, irregularly spaced B lines; multiple coalescent B lines; and normal aeration. For each of the 12 lung regions examined, PEEP-induced ultrasound changes were measured, and an ultrasound reaeration score was calculated. A highly significant correlation was found between PEEP-induced lung recruitment measured by PV curves and ultrasound reaeration score (Rho = 0.88; P < 0.0001). An ultrasound reaeration score of +8 or higher was associated with a PEEP-induced lung recruitment greater than 600 ml. An ultrasound lung reaeration score of +4 or less was associated with a PEEP-induced lung recruitment ranging from 75 to 450 ml. A statistically significant correlation was found between LUS reaeration score and PEEP-induced increase in Pa(O₂) (Rho = 0.63; P < 0.05). CONCLUSIONS: PEEP-induced lung recruitment can be adequately estimated with bedside LUS. Because LUS cannot assess PEEP-induced lung hyperinflation, it should not be the sole method for PEEP titration. |
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Authors:
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Belaïd Bouhemad; Hélène Brisson; Morgan Le-Guen; Charlotte Arbelot; Qin Lu; Jean-Jacques Rouby |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article Date: 2010-09-17 |
Journal Detail:
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Title: American journal of respiratory and critical care medicine Volume: 183 ISSN: 1535-4970 ISO Abbreviation: Am. J. Respir. Crit. Care Med. Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-02-03 Completed Date: 2011-09-29 Revised Date: 2012-03-22 |
Medline Journal Info:
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Nlm Unique ID: 9421642 Medline TA: Am J Respir Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 341-7 Citation Subset: AIM; IM |
Affiliation:
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Multidisciplinary Intensive Care Unit Pierre Viars, Assistance Publique Hôpitaux de Paris. jjrouby@invivo.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Lung Injury
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physiopathology,
therapy,
ultrasonography* Humans Lung / physiology, ultrasonography* Middle Aged Point-of-Care Systems* Positive-Pressure Respiration* Respiratory Distress Syndrome, Adult / physiopathology, therapy, ultrasonography* Respiratory Function Tests Tomography, X-Ray Computed Treatment Outcome |
| Comments/Corrections | |
Comment In:
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Am J Respir Crit Care Med. 2012 Feb 15;185(4):457; author reply 457-8
[PMID:
22336681
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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